EMERGENCY MEDICAL TECHNICIAN

ENVIRONMENTAL EMERGENCIES

Brave Training SolutionsCopyright 2014

www.bravetraining.comEMT-50 V2

DESCRIPTION

This presentation reviews recognizing the signs and symptoms of heat and cold exposure, as well as the emergency medical care of these conditions. Information on aquatic emergencies and bites and stings will also be included in this lesson. Presentation is over 190 slides in length. Meets or exceeds USDOT NHTSA 2009 EMT training requirements. Recommended classroom time 4 hours.•

EMERGENCY MEDICAL TECHNICIAN

ENVIRONMENTAL EMERGENCIES

Brave Training SolutionsCopyright 2014

www.bravetraining.comEMT-50 V2

MODULE I

SUBMERSIONINCIDENTS

UNIQUE S & S

Airway Obstructed with water immediately after rescue

BreathingMay be coughing if early rescueAgonal breaths if prolonged submersionRespiratory arrest if very prolonged submersion

CirculationMay be in cardiac arrestSkin is cyanoticSkin may be cold

SPECIAL MANAGEMENT CONSIDERATIONS

If patient is in water be aware of EMT’s personal safety

Risk of vomiting is high & if patient vomitsRoll on sideSuction mouth

CONSIDER POSSIBILITY OF SPINE INJURY

If risk of spinal injury exists, manually stabilize the neck & spineIf no risk of spinal injury exists & patient is breathing

Place in recovery positionAdminister oxygen

If no risk of spinal injury exists & patient is not breathing, follow American Heart Association guidelines for CPR

IN WATER SPINAL STABILIZATION

Stabilize the spine with manual stabilizationRestore airway & begin ventilationSecure patient to backboardRemove patient from water

AIRWAY, VENTILATION, & OXYGENATION

Suction & maintain open airwayAnticipate vomitingPosition lateral recumbent if no risk of spinal injury

Ventilate with bag-mask if impaired ventilation or respiratory arrestUse CPAP if unconscious & breathingAdminister oxygen by non-rebreather mask if breathing is adequate

TRANSPORT CONSIDERATIONS

Transport to appropriate facilityAll patients who had submersion injury with

any report of signs & symptoms during or after submersion need transport to the

hospital

WARNINGPatients have been resuscitated after up to 2

hours of submersionResuscitation efforts need to be started immediately upon getting patient to a place where resuscitation efforts can be started

MODULE II

TEMPERATURE RELATED ILLINESS

13

COLD RELATED ILLINESSES

LOSS OF BODY HEAT

The amount & rate of heat loss or gain can be changed in 3 ways

Increased or decreased heat production

(Activity or inactivity)Going into a warmer or colder

environmentWearing insulated clothing

HYPOTHERMIA

Body temperature lowered below 95o F (35o F)Infants & elderly are at higher riskIllness & injury increases susceptibility for hypothermiaEnvironment does not have to be freezing for

risk of hypothermia

SIGNS & SYMPTOMS OF GENERALIZED HYPOTHERMIA

Obvious exposureSubtle exposure

Underlying illnessOverdose/poisoningAmbient temperature decreased (e.g., cool

home of elderly patient)

SIGNS & SYMPTOMS OF GENERALIZED HYPOTHERMIA

Cool/cold skin temperaturePlace the back of your hand between the

clothing & the patient's abdomen to assess the general temperature of the patient

The patient experiencing a generalized coldemergency will present with cool or cold

abdominal skin temperature iv. shivering

SIGNS & SYMPTOMS OF GENERALIZED HYPOTHERMIA

Decreasing mental status or motor functionDepends on the degree of hypothermiaPoor coordination Mood changesMemory disturbances/confusionReduced or loss of touch sensationLess communicative DizzinessSpeech difficultyStiff or rigid postureMuscular rigidity Slow pulsePoor judgment – patient may actually remove clothingComplaints of joint/muscle stiffness

SWISS SYSTEM OF HYPOTHERMIA CLASSIFICATION

Stage Symptoms By Degree

Temperature

1 Awake & shivering

Mild 89.6-95.0o F (32-35o C)

2 Drowsy & not shivering

Moderate 82.4-89.6o F (28-32o C)

3 Unconscious, not shivering

Severe 68.0-82.4o F (20-28o C)

4 No vital signs Profound <68.0o F (20o C)

DO NOT

Allow patient to walk, eat, use any stimulants, smoke (including e-cigarettes)or chew

tobaccoMassage extremities

LOCAL COLD EMERGENCIES

Freezing or near freezing of a body partUsually occurs in fingers, toes, face, ears, & nose

THREE TYPES

FrostnipFreezing of the outer skin but not the deeper surface

Immersion foot (Trench foot)Prolonged exposure to cold water

FrostbiteFreezing of a body part, normally an extremity

REWARMING BATH

Water temperature should be 100-102o FRegularly recheck temperature & Circulate water Keep affected body part in water until rewarmed & sensation returnsDress affected area with dry sterile dressings

MANAGEMENT CONSIDERATIONSFOR COLD RELATED LOCALIZED ILLINESS

Move patient out of cold environmentAdminister oxygenConsider active rewarming if no chance of re- injuryImmerse part in tepid (100 – 105 degrees Fahrenheit)

waterAfter rewarming, apply sterile dressingsKeep patient warmTransport as soon as possible

HEAT RELATED EMERGENCIES

HEAT EXPOSURE

Normal body temperature is 98.6o FBody cools by dilation of blood vessels & sweatingBody will attempt to maintain it’s temperature

despite ambient temperatureHumidity & temperatures may defeat body’s

temperature control mechanisms

PATHPHYSIOLOGY OFHEAT RELATED ILLINESS

Patient with moist, pale, cool skin – excessive fluid & salt loss

Patient with hot, dry skinTrue emergencySeen on hot, humid days in patients with fluid &

salt lossBody unable to regulate temperature

SIGNS & SYMPTOMS OF HEAT RELATED ILLINESS

Moist, Pale SkinMuscle crampsChange in level of consciousness, dizzinessWeaknessWeak, rapid pulseNausea & vomitingApply pulse oximetry

MODULE III

BITES & STINGS

PATHYPHYSIOLOGY OF BITES & ENVENMATIONS

Spider bites (black widow) -- inject neurotoxins

PATHYPHYSIOLOGY OF BITES & ENVENMATIONS

Snake bites -- rattlesnake is most common in United States

Toxins affect blood & nervous system both at the bite site & systemically

Patient age & size cause different effectsAmount of toxin injected is related to

toxicity (often none at all)Initial 6-8 hours of care is essential

BLACK WIDOW SPIDER

Found in all states except AlaskaHas a distinctive red-orange hour glass marking

on abdomenDamages nerve tissueNo recent reported deaths

in the USAnti-venom primarily used for pain relief

4 TYPES OF VENOMOUS SNAKES IN THE USRattle Snake

Cottonmouth

CopperheadCoral Snake

CORAL SNAKE

Small snake with red, yellow, & black bands

“Red on black, friend of Jack. Red on yellow kills a fellow” or “yellow, red, stop” for North America

Primarily found in southern statesInjects venom with teeth, using a chewing motion which leaves puncture wounds

SCORPION STINGS

Venom gland & stinger in tailPrimarily found in SE StatesMost species stings are only

painful except the “Centruroides sculpturatus”

TICK BITES

Ticks bite the skin & attach to skinBite is not painful, but potential

for infectionTick bites can carry Rocky Mountain Spotted

Fever, Lyme Disease, Typhus, Tularemia, Colorado Tick Fever, & others

TICK BITES

EMS careWash & disinfectareaRemove tick with tick tweezersTransport if indicated

MODULE IV

DIVING INJURIES

DIVING INJURIES(DYSBARISM)

Mechanism of InjurySCUBA diving at greater depths for long

periods of timeRepeated dives at depth on the same day

DECOMPRESSION SICKNESS

AKA Caisson disease, bendsA condition arising from the dissolved gases coming out of solution forming bubbles as the diver ascends from depthWith current technology divers can stay under

pressure for months at a time with long decompression times

S & S OF DECOMPRESSION SICKNESS

Joint pain Primarily large joints 60-70% of time

SkinItching, sensation of insect bites, mottled

or marbled, swelling of the skinS & S may not show up for hours after surfacing

FLYING

Most aircraft fly with lower cabin pressures than at sea level

This could cause a diver to have the gases in the blood stream to surface causing the bends

Divers who may have needed decompression are told to refrain from flying for 48 hours after their dive

AIR EMBOLISM

Signs & symptomsBlotching of skin Froth at mouth &

noseSevere muscle, joint, & abdominal painDyspnea &/or chest pain

DysphasiaDizziness Nausea VomitingVision difficulties Paralysis &/or

comaIrregular pulse or cardiac arrest

EAR SQUEEZE

Caused by blockage of Eustachian tubes orfailure to clear ears during descent

S & SPain in ear on assentRinging in earsBleeding from the ear

MODULE V

MARINE ANIMAL INJURIES

MARINE ANIMAL INJURIES

Numerous aquatic animals have toxic bites or stingsThey include

Sea urchinJelly fishPortuguese man of warFire coralCone SnailStingrayTorpedo Ray

SEA URCHIN INJURY

Hard spines are brittle & can easily break off upon entering the skin

JELLYFISH

Has nematocysts that can be triggered by touch & inject venom into the skinBeached or dead jellyfish may stingSome species may be deadly

PORTUGUESE MAN O WAR

Float on surface with tentacles that may reach 30 feet which have stinging nematocysts

FIRE CORAL

Not a true coral but related to the jellyfish

Stings in similar manor as jellyfish with similar S & S, & EMS careDivers often mistake fire coral

for regular coral

CONE SNAIL

They have a harpoon which can penetrate a

wetsuitThe harpoon injects a an

analgesic which with some species can kill

a human in 5 minutesby paralyzing the victim

STINGRAY

Most injuries are caused by stepping on their venomous stinger

Estimated 2,000 injuries annually in US

Stinger in cm

MODULE VI

LIGHTNINGEFFECT OF THE SUN

ELECTRICAL INJURIES

Skin wounds may not indicate seriousness of burn

Entrance & exit woundsMay cause cardiac arrest or other cardiac arrhythmiasLighting strikes may cause cardiac arrest

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